Tympanostomy tubes and otic drops

Otic drops have been proposed as a form of prophylaxis against the otitis media which follows middle ear contamination by water in patients with tympanostomy tubes. The potential adverse effects of this form of therapy were studied in chinchillas with tympanostomy tubes; 31 chinchillas underwent bilateral tympanostomy tube insertion. Seven animals had a mixture of green dye and Cortisporin otic suspension placed in both external auditory canals 24 hours following the placement of tympanostomy tubes and were sacrificed 30 minutes later for gross examination; 3 of these animals had previous eustachian tube obstruction with Silastic sponge. Twenty-one animals had Cortisporin otic suspension placed in the right external auditory canal on postoperative days 3, 4, 5, 6 and 7. No otic drops were placed in the left ear. Ten of these 20 animals had VIIIth nerve action potentials measured on postoperative day 17 and the other 11 animals had VIIIth nerve action potentials measured on postoperative day 42 followed by immediate sacrifice for histological examination and scanning electronmicroscopy. The remaining 3 animals had VIIIth nerve action potentials measured 21 days following tympanostomy tube insertion and served as electrophysiological controls. The 8 ears receiving Cortisporin otic drops mixed with green dye from animals with normal eustachian tubes showed staining of the round window membrane at sacrifice, while the 6 ears receiving Cortisporin otic suspension and green dye from animals with eustachian tube obstruction demonstrated no dye in the middle ear. All animals receiving Cortisporin otic drops in the right ear showed an intra-aural difference in action potentials with the right ear being attenuated by an average of 10.3 dB at 2,000 Hz, 12 dB at 4,000 Hz, 21 dB and 8,000 Hz, and 26 dB at 12,000 Hz. Morphological study revealed hair cell loss in the hook portion of the cochlea in those animals receiving Cortisporin otic drops. It was concluded from this study that, in patients with patent tympanostomy tubes in place, potentially ototoxic topical agents should be used with caution.     

Swimming and tympanostomy tubes: a prospective study

To prevent ear infection, many physicians advise their patients to avoid water after insertion of tympanostomy tubes. This advice is a logical extension of the supposition that contaminated water entering the middle ear through the tube may cause an infection. While tympanostomy tubes have been in widespread use for over 30 years, very few prospective clinical trials have evaluated their use while swimming. This study evaluated 85 patients with tympanostomy tubes divided into three groups: swimming without earplugs, swimming with earplugs, and no swimming. The infection rates were 16%, 30%, and 30% in the three groups, respectively. We conclude that swimming without earplugs does not result in an increased incidence of middle ear infections.     

Inflammatory effects of otic drops on the middle ear

Combination topical otic preparations are used to treat many infections of the external and middle ears. Despite the presence of ototoxic drugs in a number of these drops and convincing evidence of sensorineural hearing loss in humans and animal studies (Meyerhoff et al., presented at Southern Section Triological Meeting, Jan. 1983) following use of these medications, otic drops remain the cornerstone of treatment for many infectious disorders of the ear. Twelve chinchillas underwent bilateral tympanostomy tube placement and daily instillation of Cortisporin Otic Suspension (polymyxin B, neomycin, hydrocortisone, propylene glycol) in the right external auditory canal for 7 consecutive days. The animals were sacrificed 3 days later, 10 days following initiation of the Cortisporin Otic Suspension treatment. Following routine preparation of the temporal bones for light microscopy, the tissue was evaluated for evidence of inflammatory changes. All 12 animals demonstrated granulation tissue, effusion and focal hemorrhage in the ears subjected to the Cortisporin Otic Suspension. All of the contralateral control ears were normal. The present data suggest that this inflammatory response is due to a topical irritant effect of the otic preparation.     

The role of laser assisted tympanostomy (LAT) in treating allergic children with chronic serous otitis media

OBJECTIVES: To assess various prognostic factors influencing the outcome in paediatric patients with serous otitis media, who have undergone laser assisted tympanostomy without ventilation tube placement. Emphasis is given to children with allergies who underwent the procedure. METHOD: Laser assisted tympanostomy was performed on a total of 130 ears (92 individuals) with chronic otitis media with effusion. To determine the quality of patient outcome, the following parameters were evaluated: external auditory canal anatomy, type of anaesthesia used, tympanic membrane and middle ear fluid characteristics, myringotomy size, a history of allergies and the laser device parameters. RESULTS: Multivariable statistical analysis demonstrated that the presence of allergies in children with chronic serous otitis media is significantly correlated with a poor outcome (P < 0.0047). Moreover, the presence of a thick tympanic membrane and/or high viscosity (glue) fluid in the middle ear cavity can also independently influence patient outcome (P < 0.025). Simultaneous adenoidectomy and/or tonsillectomy, type of anaesthesia (general versus local), external canal anatomy (wide or narrow) and sex, were not statistically important prognostic factors. The type of anaesthesia used, myringotomy size and the laser device parameters were not found to be associated with patient outcome. CONCLUSION: A history of allergies, the presence of a thick tympanic membrane and/or high viscosity fluid in the middle ear cavity are all contraindications for laser assisted tympanostomy without tympanostomy tubes, in children who suffer from chronic serous otitis media. The selection criteria for this procedure in the paediatric population are addressed in detail.     

Medial migration of tympanostomy tubes: an overlooked complication

BACKGROUND: Frequently encountered complications associated with tympanostomy tube placement have been well documented and are globally recognized. The medial migration of tympanostomy tubes into the middle ear space is a rare complication for which pathogenesis, natural history, and management have not been clearly delineated. OBJECTIVE: To describe our experience with the medial migration of tympanostomy tubes into the middle ear space. To propose a simple classification system and define management recommendations. METHODS: A retrospective chart review of all patients with medial tube migration seen in a Pediatric Otolaryngology practice at a tertiary care university hospital between 1995 and 2005. RESULTS: Six pediatric patients (ages 3-19) were found to have seven tympanostomy tubes within the middle ear space at various intervals following tube placement. One patient had a migrated tympanostomy tube deep to a large myringotomy incision. Five patients (six ears) had migrated tubes medial to intact, healed tympanic membranes. Fifty percent of the patients had symptoms attributable to the migrated tube. All six patients underwent middle ear exploration with successful removal of the migrated tube. CONCLUSIONS: This process can be defined as primary, when the tympanostomy tube migrates due to a technical error, or secondary, when the tube is initially seen in the correct position but is later found medial to a healed, intact tympanic membrane. Medial migration is apparently independent of tube type and can occur at various intervals after placement. The process of secondary migration is most likely multifactorial but may in part be the result of persistent negative middle ear pressure. Migrated tubes should be removed surgically unless contraindicated.     

Post-myringotomy care: a prospective study

Children with tympanostomy tubes have always been considered somewhat handicapped in regard to swimming and bathing. Their parents had to maintain constant surveillance to prevent then from getting water in their ears. A prospective study involving more than 1,000 children was conducted between June 1981 and August 1982 on two groups of randomly selected patients to determine the prevalence of suppurative otitis media and its relationship to bathing and swimming. One group had to follow strict rules to prevent water entering the ear (bathing caps, earplugs) whereas the other group was allowed to bathe and swim without any precaution upon the condition of using a polymyxin B/gramicidin ear drop combination at bedtime on the day they swam. The study shows no increase in prevalence of suppurative otitis media in the "open canal" group as compared to the "closed canal" group. Furthermore, the monthly distribution of infections shows a relatively evan distribution throughout the year. This study implies that swimming and bathing are safe for the vast majority of children with tympanostomy tubes and thus simplifies enormously the post-myringotomy care for the child, the parents, and the physician.     

Safety of ototopical antibiotics

A prospective randomized study analyzing the safety and efficacy of a single dose of ototopical antibiotics following human middle ear tympanostomy tube insertion was performed. Fifty children undergoing bilateral tympanostomy tube insertion were studied by the placement of 0.5 mL of Cortisporin Otic Suspension (COS; Burroughs Wellcome Co., Research Triangle Park, N.C.) to one middle ear space by random assignment. Preoperative and postoperative audiograms were obtained, and the presence of otorrhea was noted. In one patient sensorineural hearing loss of 6 dB developed bilaterally, which was symmetric in both the treated and the untreated ear. This preliminary study showed no statistical difference in hearing loss or postoperative otorrhea associated with a single application of Cortisporin to the middle ear space.     

The effect of topical ciprofloxacin on postoperative otorrhea after tympanostomy tube insertion.

OBJECTIVE: This study aimed to evaluate the effectiveness of prophylactic ciprofloxacin drops in decreasing the incidence of otorrhea after tympanostomy tube insertion. STUDY DESIGN: The study design was a single-blind, randomized clinical trial. SETTING: The study was conducted at a tertiary care referral center. PATIENTS: One hundred fifty-four patients aged 6 months to 14 years undergoing tympanostomy tube insertion participated. INTERVENTION: For each subject, one ear was randomly assigned to receive topical ciprofloxacin, placed in the middle and external ear after surgery, while the contralateral ear served as a control. MAIN OUTCOME MEASURE: Posttympanostomy otorrhea occurring during the period from 24 hours after surgery until 2 weeks after surgery was measured. RESULTS: Topical ciprofloxacin application after tympanostomy tube insertion was associated with a significantly lower incidence of early posttympanostomy otorrhea. The rates of otorrhea for control and treatment ears were 9.1% and 3.9%, respectively (p = 0.029). CONCLUSIONS: The topical administration of a single dose of ciprofloxacin solution after surgery is an effective treatment for the prevention of early posttympanostomy otorrhea.     

钛金属管网状支架在外耳道重建术中的应用

目的观察钛金属管网状支架在先天性外耳道闭锁外耳道重建术中的作用,评估钛金属管网状支架预防外耳道重建术后外耳道再度狭窄或闭锁的疗效。方法 16例（16耳）先天性外耳道闭锁患者同期行外耳道和中耳成型术,在成形的外耳道内置钛金属管网状支架支撑;术后14 d取出外耳道内填塞物,保留内置的支撑钛金属管网支架,并于1年后取出。结果术后随访2年,全部病例新成形的外耳道形态良好,局部无感染与肉芽组织增生,无再度狭窄或闭锁。结论外耳道成形术中应用钛金属管网状支架支撑成形的外耳道,对预防术后外耳道再度狭窄或闭锁具有良好效果。     

First branchial cleft sinus presenting with cholesteatoma and external auditory canal atresia

First branchial cleft abnormalities are rare. They may involve the external auditory canal and middle ear. We describe a 6-year-old girl with congenital external auditory canal atresia, microtia, and cholesteatoma of mastoid and middle ear in addition to the first branchial cleft abnormalities. Clinical features of the patient are briefly described and the embryological relationship between first branchial cleft anomaly and external auditory canal atresia is discussed. The surgical management of these lesions may be performed, both the complete excision of the sinus and reconstructive otologic surgery.     

Middle ear ventilation with the castelli membrane tube.

This report evaluates the use of the Castelli type membrane tympanostomy tube in combination with adenoidectomy or adenotonsillectomy. One hundred and sixty two ears were studied. Children with mucoid or seromucoid fluid only were included. The ears were unprotected during swimming, bathing, etc. The average length of intubation was 7 months; 7 1/2% developed middle ear problems with the tubes in place and 7% developed external ear problems. All of these complications were treated without residua.     

局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎

目的：探讨局麻下咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎的临床疗效。方法收集顽固性分泌性中耳炎患者20例（24耳）,于门诊局麻下,结合鼻内镜经鼻腔径路行咽鼓管咽口球囊扩张,并行鼓膜置管。所有患者均于术后3个月拔出T型管。结果术后随访6个月,18例患者耳闷塞感、听物朦胧感症状明显减轻,未再出现鼓室内积液。2例术后仍有耳内闷胀及听力下降,耳内镜检查示鼓室积液未吸收,再次置入T型通气管后症状改善。结论局麻下行咽鼓管球囊扩张术加鼓膜置管术治疗顽固性分泌性中耳炎疗效显著,对于改善咽鼓管功能方法安全可行,并发症极小,是一种微创的新方法。     

Unusual extension of the first branchial cleft anomaly

First branchial cleft is the only branchial structure that persists as the external ear canal, while all other clefts are resorbed. Incomplete obliteration and the degree of closure cause the varied types of first branchial cleft anomalies. They were classified based on the anatomical and histological features. We present an unusual type of first branchial cleft anomaly involving the external auditory canal, the middle ear and the nasopharynx through the eustachian tube.     

MMP9蛋白与微血管密度在外耳道及中耳鳞状细胞癌中的表达及其临床意义

目的:检测MMP9蛋白与微血管密度(MVD)在外耳道及中耳鳞状细胞癌中的表达,并研究其临床意义.方法:采用免疫组织化学SP法检测26例外耳道及中耳鳞状细胞癌组织中MMP9与CD34标记的MVD.结果:外耳道及中耳鳞状细胞癌组织中MMP9表达阳性率为73.1%(19/26),正常外耳道皮肤中阳性表达率为25.0%(5/20),2组间比较差异有统计学意义(x<'2>=12.615,P<0.05);外耳道及中耳鳞状细胞癌组织中CD34标记的MVD表达为33.58±3.04,正常外耳道皮肤中表达为22.50±5.22,2组比较差异有统计学意义(P<0.01).外耳道及中耳鳞状细胞癌组织中MMP9蛋白的表达和MVD与组织学分级和肿瘤分期密切相关,而在不同年龄和性别的患者中其表达差异无统计学意义.MMP9和CD34蛋白的表达经Pearson相关检验呈正相关关系(r=0.42,P<0.05).结论:MMP9可能参与了外耳道及中耳鳞状细胞癌的发生,在外耳道及中耳鳞状细胞癌的侵袭和转移中发挥着重要作用,联合检测MMP9与MVD可望成为外耳道及中耳鳞状细胞癌早期诊断和预后判断的分子指标之一.     

外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习

目的 探讨外耳道胆脂瘤并发化脓性腮腺炎病因及诊治经验,并进行外耳道胆脂瘤诊疗相关文献复习。 方法 回顾性分析1例外耳道胆脂瘤并发化脓性腮腺炎病例资料,主要症状为左耳听力下降伴流脓,左侧面部红肿疼痛。颞骨CT及耳部核磁示:左侧外耳道内胆脂瘤形成,累及乳突、鼓室、鼓窦、腮腺及咽旁间隙。临床诊断:外耳道胆脂瘤(左,Holt Ⅲ期)、化脓性腮腺炎(左)。手术方式为左耳外耳道胆脂瘤切除术、开放式乳突根治术、鼓室成形术、人工听骨植入术、耳甲腔成形术、腮腺脓肿清除术及腮腺瘘修补术。 结果 术中彻底清除外耳道及中耳内胆脂瘤及腮腺脓肿,并修复腮腺瘘。术后随访患者恢复良好,无胆脂瘤复发残留及腮腺炎复发相关症状出现。 结论 外耳道胆脂瘤具有骨质破坏的潜能。而HoltⅢ期外耳道胆脂瘤并发化脓性腮腺炎病例罕见,明确病因并依据病变侵袭范围选择个体化的治疗方案尤为关键。     

Tuberculous otitis media developing as a complication of tympanostomy tube insertion

Primary tuberculous otitis media of which infection focus cannot be found elsewhere in the body is a rare disease. Route of the infection has been hypothesized as Eustachian tube or external auditory canal with tympanic membrane perforation but it is hard to ascertain in the patient. We present a case of an 8-year-old child who suffered chronic otorrhea after tympanostomy tube insertion. The radiological and histopathological findings revealed tuberculous otitis media, which occurred as a complication of tympanostomy tube insertion.     

Transient-evoked otoacoustic emissions from ears with tympanostomy tubes

OBJECTIVE: Otoacoustic emissions (OAEs) are low-level acoustic signals which emanate from the cochlea and can be recorded in the ear canal. The two types of OAEs are spontaneous and evoked otoacoustic emissions. METHODS: In this retrospective study, transient-evoked otoacoustic emissions (TEOAEs) were measured in 385 ears from 204 children with normal hearing and tympanostomy tubes. RESULTS: The results indicate that, when using the Quick Screen option on the Oto-Dynamics ILO88 Otoacoustic Emission Analyzer, postoperative TEOAEs were present at all measured frequencies in 81% of the ears. The remaining 19% of ears showed the absence of an observable emission at one or more of the measured response frequencies. The overwhelming factor contributing to an absent emission was insufficient stimulus energy at 4 kHz. The use of T-type tympanostomy tubes also appeared to decrease the probabilities obtaining normal TEOAEs in ears with normal peripheral auditory function. The use of grommet-type tympanostomy tubes, the type of middle ear effusion, the age and gender of the child, and the physical volume of the ear canal as measured by tympanometry with the tympanostomy tube patent and in place had negligible effects on the measurement of TEOAEs. CONCLUSIONS: Clinicians must be cautious when interpreting click-evoked TEAOEs if the patient has a T-tube in place and may need to modify this testing to rule out high-frequency hearing loss when using TEOAEs with these patients. For those patients who have tympanostomy tubes and fail to meet the "pass criteria" for TEOAEs at 4 kHz in the Quick Screen option, TEOAE should be repeated either in the Diagnostic mode or by using a 4 kHz tone-burst stimulus centered at 4 kHz to recover the loss of energy in this region due to the high-frequency roll-off of the stimuli used in the Quick Screen option.     

How we do it: Stapes surgery without postoperative packing of the external auditory canal

? Packing of the external auditory canal after ear surgery has been a clinical practice to assure haemostasis and to allow reposited ear canal skin to heal. ? The healing of minor transcanal incision without any postoperative tamponation or local medication has not been reported. ? The treatment rationale was local anaesthesia, tympanomeatal flap through a speculum, careful reposition of the flap, and neither packing nor ear drops to the external auditory canal postoperatively. ? The postoperative complications were rare and temporary. ? The external auditory canals remained patent postoperatively in significant proportion of the patients despite some blood clot accumulation. Thus the need for scheduled follow‐up visits with this treatment rationale seems to be reduced.     

Is Aspiration Necessary Before Tympanostomy Tube Insertion?

Aspiration of middle ear fluid after myringotomy is performed routinely, although investigators imply a cause-and-effect relationship between suction noise and acoustic trauma. This prospective randomized study investigated if aspiration was necessary. Fifty-one myringotomies and 50 tympanostomy tube insertions were performed on 27 patients. A suction instrument was utilized in 24 ears and was not used in 27 ears. In a follow-up period, no difference was observed between the two groups. The authors did not establish that aspiration is indeed harmful, but tympanostomy tube insertion can be performed without suctioning middle ear effusion.     

Cavernous haemangioma of the external auditory canal: clinical case and review of the literature

Although benign vascular lesions are frequent in the head and the neck region, clinical evidence of cavernous haemangioma of the external auditory canal is extremely rare; when present, the lesion invades the middle ear space. Herein, a rare case of a soft mass filling the external auditory canal, not involving the tympanic membrane, in a symptomatic 59-year-old male is described. Clinical and audiological characteristics, imaging studies and surgical treatment with histological evaluation are reported, which led to a diagnosis of a cavernous haemangioma. This is only the seventh case described in the literature, to date, not involving the tympanic membrane and the middle ear space. In addition, a review has been made of the relevant literature with respect to epidemiology, presentation, evaluation, pathology, and management options for haemangiomas arising in the external auditory canal.